Senior Investigator - Pre-Pay (Healthcare FWA)

Cotiviti•Remote,

2d•$70,000 - $90,000•Remote

About The Position

As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis (a high level of proficiency with Excel is required). This is not a physical investigator role. This role aligns with our pre-pay Fraud Waste & Abuse team.

Requirements

Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience.
5-8 years of related healthcare FWA investigative experience.
Experience in proactive data mining.
Advanced level skills in Excel required.
Excellent verbal and written communication skills.
Strong listening and observation skills.
Attention to detail and high level of accuracy.
Effective organizational and prioritization skills with multi-tasking ability.
Must be able to provide a dedicated, secure work area.
Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Nice To Haves

Experience using Cotiviti FWA tools (preferred) - Sentinel, Commander, and/or Informant (Stars Solutions).
Accredited Healthcare Fraud Investigator (AHFI),
Certified Fraud Specialist (CFS),
Certified Fraud Examiner (CFE),
Certified Forensic Interviewer (CFI), or
Certified in Healthcare Compliance (CHC).

Responsibilities

Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse.
Proactively monitors provider activity to identify patterns, anomalies, and emerging trends that may warrant further investigation.
Utilizes data analytics, claims review, and industry intelligence to detect potential fraud, waste, abuse, or non-compliance.
Leverages claims data, dashboards, and predictive models to identify providers exhibiting atypical billing patterns or potential fraud, waste, and abuse.
Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation.
Conducts investigation-related training.
Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions.
Maintain current knowledge of relevant laws, regulations and standards.
Complete all responsibilities as outlined on annual Performance Plan.
Complete all special projects and other duties as assigned.
Must be able to perform duties with or without reasonable accommodation.